Reverse screw technique for guidewire placement in dhs surgery

Introduction: DHS is a commonly used fixation procedure in stable inter-trochantric fractures. The proper placement of lag screw is important in reducing the incidence of implant failure which depends upon the fluoroscopically assisted placement of guide pin in centre –centre position. This guide pin often gets erroneously removed during reaming or tapping procedures mostly in osteoporotic patients. We studied the incidence of inadvertent guide pin removal in DHS procedure and its association with osteoporosis, With an overview of repositioning of this guide pin using reverse screw technique. Methods: We conducted a prospective study on 100 patients with stable inter-trochantric fractures. We graded the osteoporosis according to Singh index grading system. The incidence of inadvertent removal of guide pin during reaming or tapping procedure and its association with osteoporosis was studied. Results: 100 patients with stable trochantric fractures underwent DHS procedure. Guide pin got removed in 70 patients out of which Singh index 3 or less than 3 was present in 58 patients. Conclusion: On the basis of the study, We found that the erroneous withdrawal of guide pin during reaming or tapping occurs more often in patient with poor bone stock that is Singh Index 3 or less than 3. The primary placement of guide pin should be up to subchondral bone and reaming or tapping should be done gently and carefully and reaming should not be done beyond the guide pin. The reverse screw technique for guide pin placement is an effective method in inadvertently removed guide pin.